- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.45 / $2,079.00 / $3,625.00
| Facility | | $539.45 | $2,079.00 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.92 / $812.38 / $1,222.27
| Professional | | $533.92 | $812.38 | $1,222.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.36 / $1,267.00 / $3,956.96
| Facility | | $560.36 | $1,267.00 | $3,956.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.28 / $1,004.76 / $3,914.76
| Professional | | $421.28 | $1,004.76 | $3,914.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.19 / $763.47 / $1,349.31
| Facility | | $588.19 | $763.47 | $1,349.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.31 / $360.31 / $360.31
| Professional | | $360.31 | $360.31 | $360.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.64 / $375.64 / $375.64
| Facility | | $375.64 | $375.64 | $375.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.73 / $1,012.69 / $1,741.09
| Professional | | $537.73 | $1,012.69 | $1,741.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $804.38 / $8,090.00
| Facility | | $300.00 | $804.38 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.03 / $728.64 / $1,005.80
| Professional | | $581.03 | $728.64 | $1,005.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $606.21 / $1,196.66 / $1,585.30
| Professional | | $606.21 | $1,196.66 | $1,585.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.34 / $1,813.34 / $1,813.34
| Facility | | $1,813.34 | $1,813.34 | $1,813.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $7,161.00
| Facility | | $55.00 | $2,078.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.11 / $1,278.36 / $5,641.13
| Professional | | $631.11 | $1,278.36 | $5,641.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.30 / $1,878.00 / $4,142.00
| Facility | | $738.30 | $1,878.00 | $4,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.46 / $1,010.20 / $1,567.21
| Professional | | $579.46 | $1,010.20 | $1,567.21 |